Outcome of Esophageal Carcinoma in the Veteran Affairs Population A Comparative Analysis From the Veteran Affairs Central Cancer Registry

Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Cincinnati and Cincinnati VA Medical Center, Cincinnati, OH 45267, USA.
American journal of clinical oncology (Impact Factor: 3.06). 06/2009; 32(3):286-90. DOI: 10.1097/COC.0b013e31818af0d8
Source: PubMed


Reports indicate that esophageal carcinoma is changing with a shift from squamous cell carcinoma (SCC) to adenocarcinoma (AC) along with worse survival in black patients. However, data on esophageal carcinoma in the Veteran Affairs (VA) population is lacking. We set to describe site-specific and histology-specific characteristics of esophageal cancer in the VA population over the past decades.
We queried the VA Central Cancer Registry database for esophageal cancer cases between 1995 and 2005. Patient characteristics and treatment methods were obtained and overall survival was estimated using the Kaplan-Meier method.
There were 7929 patients included in the study. The median survival in the period 1995 to 1999 was 7.53 months and 2000 to 2005 was 8.33 months. The median survival in AC was 8.93 months; SCC was 7.30 months. Cox-regression multivariate model revealed that location, age, histology, stage, and treatment were independent predictors of survival. Blacks were less likely to undergo surgery and more likely to undergo radiation.
In nonmetastatic esophageal cancer at the VA, SCC has worse outcome as compared with AC. Blacks with AC have worse outcome than whites. Despite equal access to health care blacks are less likely to undergo surgery, which may contribute to their worse outcome. We recommend further studies to determine factors leading to selection of treatment modalities in minority patients.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Minimally invasive esophagectomy (MIE) has been performed at specialized centers for 15 years, but few studies have looked at outcomes in patients with locally advanced cancers, and few studies have provided long-term survival comparison with Ivor Lewis esophagectomy (ILE) to determine oncologic benefit or equivalence of MIE. Minimally invasive esophagectomy for locally advanced esophageal carcinoma has similar oncologic outcomes to traditional open ILE with less associated short-term morbidity and mortality. Retrospective comparison of patients with stage II or III esophageal carcinoma undergoing 3-field MIE compared with open ILE. University medical center. From 1995 to 2009, 64 patients who underwent MIE (33 patients) or ILE (31 patients) with clinical stage II or III esophageal cancer were compared. Primary end points included operative performance, morbidity, mortality, hospital stay, and survival. No differences were noted between the groups in demographics, neoadjuvant therapy use (P = .22), resection completeness (R0:R1) (P = .57), length of stay (P = .59), intensive care unit stay (P = .36), anastomotic leak (P = 1.0), pulmonary morbidity (P = .26), and mortality (P = 1.0). Median follow-up was 19 months for MIE and 17 months for ILE. Survival at 2 years was 55% for MIE (18 of 33 patients) and 32% for ILE (10 of 31 patients) while disease-free survival was 55% for MIE (18) and 26% for ILE (8). Our survival analysis shows divergent curves that favor MIE but have not yet reached statistical significance. The oncologic outcomes of MIE are comparable to that of ILE 2 years after resection.
    No preview · Article · Jun 2011 · Archives of surgery (Chicago, Ill.: 1960)